Infrastructure Bill Still Establishing a Foundation

President Biden’s Infrastructure Bill package has been reduced to a total spend somewhere in the neighborhood of $1.75 trillion. However, at least Senator Manchin from WV has indicated that he still won’t vote in favor until the impact on the economy can be scored by the CBO.

The House of Representatives has released language for the Build Back Better (BBB) Act, the social spending aspect of the infrastructure proposal. In total the BBB Act calls for $1.75 trillion in spending, down from a previously planned $3.5 trillion.

A key provision in the BBB provides a $150 billion investment in Medicaid HCBS Services. These funds will go towards:

  • 7% FMAP increase specific for HCBS through September of 2031
  • Maintenance of effort – new funds may only be used to supplement, not supplant current state spending on HCBS
  • Required coverage of personal care services
  • Support for family caregivers to include respite care
  • Requires states to update and increase payment rates to support recruitment and retention of direct care workers
  • Requires states to review and if necessary, increase payment rates to ensure sufficient access to care every 3 years
  • Makes permanent the Medicaid Money Follows the Person demonstration program
  • Makes permanent the protections against spousal impoverishment for HCBS beneficiaries.
  • Full legislative language here, HCBS part starts on page 568.

Negotiations are still not complete, leaving room for the possibility of further changes to the legislative text.